Provider Demographics
NPI:1164993721
Name:CHAVANNES, DIAMOND (LMSW)
Entity type:Individual
Prefix:
First Name:DIAMOND
Middle Name:
Last Name:CHAVANNES
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 W 125TH ST FRNT 1
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10027-4444
Mailing Address - Country:US
Mailing Address - Phone:347-305-4858
Mailing Address - Fax:
Practice Address - Street 1:105 W 125TH ST FRNT 1
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10027-4444
Practice Address - Country:US
Practice Address - Phone:347-508-4858
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-07
Last Update Date:2024-06-13
Deactivation Date:2020-11-12
Deactivation Code:
Reactivation Date:2024-06-13
Provider Licenses
StateLicense IDTaxonomies
NJ44SL07070900104100000X
NY122093104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker